Mothers-to-Be Are Getting the Message

We’re used to hearing about public initiatives that get mired in politics or entangled in bureaucracy, but we rarely hear about programs that exceed expectations. So here’s one: last week marked the one-year anniversary of a program called text4baby, a service that sends free text messages to women who are pregnant or whose babies are less than a year old, providing them with information, and reminders, to improve their health and the health of their babies.

The service, made available through a broad partnership of community health organizations, wireless carriers, businesses, health care providers and government health agencies, is catching on like wildfire: to date, about 135,000 women have signed up — and organizers have set a new goal of reaching one million users by the end of 2012 (there are four million births each year in the U.S.) What are they doing right?

At face value, text4baby seems deceptively simple: all you need to do is send a text message to the number 511411 with the word BABY or BEBE (for Spanish messages). You will be prompted for your due date or your child’s birth date, and your zip code, and immediately, you will begin receiving three messages a week offering actionable, evidence-based information relevant to your stage in pregnancy or your child’s development.
In his State of the Union address, President Obama said the U.S. needs to “win the future.” Well, nothing says future more than babies. And presently, the United States ranks 30th in the world in infant mortality rates — between Poland and Slovakia. About 28,000 children born in the U.S. each year die before their first birthday – and many more face disabilities and serious life-long health problems, often because they are born prematurely or at low birth weights.

Text messaging has demonstrated early promise as a tool to promote healthy behavior.

Some of the causes of poor birth outcomes are unknown. For example, medical experts cannot fully explain why the U.S. has so many pre-term births — about 500,000 a year, or one in eight, representing a 30 percent increase since 1981. What we do know is that there are clear steps that increase the odds that a mother will deliver a full-term, healthy baby who thrives in its first year. At the top of the list: making sure pregnant women pay attention to their nutrition, avoid cigarettes and alcohol, control blood pressure and diabetes, watch for infections, get flu shots and make regular prenatal doctor visits. After birth: breastfeeding, making “well baby” doctor visits, getting immunization shots and ensuring that babies sleep in a safe position, respond to cues and are held, spoken to and read to, a lot.

Of course, this information is widely available from Web sites, baby books and health care providers. But many low-income women have no Internet access. They may have limited education and little time to read. Millions also lack adequate health insurance to cover pregnancy costs. Low-income, minority women are far more likely than other women to delay prenatal care until the third trimester, or go without it altogether. Many are unaware that Medicaid offers expanded eligibility for pregnant women or that the government can provide them and their children with nutritional supports through programs like Women, Infants and Children (WIC).

Text4baby makes it easy to learn about benefits and the importance of care; it supplies 800-numbers where women can get help with things like finding a doctor, quitting smoking, buying an inexpensive crib, or getting started with breastfeeding. “We focus on what’s most important for women to know week by week,” explains Judy Meehan, the chief executive officer of the National Healthy Mothers, Healthy Babies Coalition (HMHB), which runs the program. “The baby is such a motivator for moms. Science tells us that a real behavior change leading to healthy choices can be made at this unique time.”

Meredith InmanText4baby reaches women by many means, including billboards like this one in Martinsville, Va.

To make sure women stay engaged with the service, HMHB tested the messages in community clinics and Healthy Start programs. “We worked on tone — so the messages sound like they’re coming from a friend. Not ‘you should do this’ but ‘have you thought about this?’ ” said Meehan. And based on feedback, they balanced informative messages with messages about the wonders and joy of motherhood.

All of this gets boiled down to 160 characters and, most important, delivered directly to cell phone in boxes, where the messages are most likely to get read. More than 90 percent of Americans have a mobile phone. Roughly 40 percent of U.S. births are covered by Medicaid and nearly 80 percent of Medicaid patients send and receive text messages regularly (pdf, p.4). Currently, 61 percent of text4baby users live in zip codes with household median incomes less than $50,000.

What makes text4baby notable is not the idea itself, but its execution. We often hear about “public private” partnerships as a potential answer to social problems. Most of the time the words amount to little more than a press release. It’s difficult to get people across agencies, companies and sectors to work together.

The government is hoping to apply text4baby’s lessons to smoking, obesity and other childhood health issues.

Hundreds of partners have taken up this idea enthusiastically. The National Healthy Mothers, Healthy Baby Coalition manages the program, but Meehan and her staff are happy for other health organizations to promote the service as they see fit — and take credit for it. Many groups had a hand in building it, as well. The platform for managing the text messages was created by a company called Voxiva that has pioneered mobile health services across Asia, Africa and the Americas. The content of the messages was overseen by health experts at The Centers for Disease Control and Prevention. The group responsible for persuading wireless carriers to transmit messages free of charge was CTIA-The Wireless Association, a nonprofit advocacy group. (Previously, the only other time this had been done was for “Amber alerts” — warnings about child abductions.) The largest funder is Johnson & Johnson, which has made a multi-year, multi-million dollar commitment. Grey Healthcare Group handled the branding and marketing. MTV is a media sponsor.

Then there’s the White House. The program was formally announced a year ago by Aneesh Chopra, the Chief Technology Officer of the White House Office of Science and Technology Policy. Although text4baby isn’t a government initiative, the White House has energized support for the program from numerous agencies. The Department of Health and Human Services (H.H.S.) is championing the service through state-level health agencies and federally funded health centers, and funding evaluations. The USDA, which oversees the WIC program, disseminates information about text4baby through its offices across the country. Many other government branches participate, including the Department of Defense, which is evaluating the program’s impact on military families.

In some states, women learn about text4baby when they apply for Medicaid. In New York City, every birth certificate advertises the program. Information reaches mothers in all 50 states in other ways, too: through libraries, churches, billboard ads, health care providers, employers, health fairs and networks like the American Academy of Pediatrics. It was recently featured on the MTV reality TV show, “16 and Pregnant.” Currently, there are more than 500 organizations involved.

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The partnership seems to have evolved a spirit of mutual appreciation — with leaders taking pains to acknowledge everyone’s contributions. It’s been said that there is no limit to what you can achieve — if you don’t care who gets the credit. I interviewed numerous people, including Meehan, Chopra and others, who played key roles in text4baby — and I was struck that not one stressed their own role.

As the service continues to add users, its influence is spreading. Recently, Todd Park, the Chief Technology Officer for Health and Human Services, announced a Text4Health taskforce to determine how to apply text4baby’s lessons to smoking, obesity, and other childhood health issues. And this past June, Secretary of State Hillary Clinton announced a partnership between HMHB and the Healthy Russia Foundation to launch text4baby in Russia.

Currently, 96 percent of users say they would recommend the service to a friend. Doctors report anecdotally that they are seeing a positive impact on mothers’ behavior. But the big news will come with the evaluation results. Does the service increase prenatal care? Can something as simple as text messages be linked to better birth outcomes?

Meehan is hopeful. “There’s a reason why our birth statistics are the way they are,” she says. “There’s an awful lot to remember when you’re pregnant. We can make it easier.”